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==Overview==
==Overview==
'''Lymphadenopathy''' (also known as "enlarged lymph nodes") refers to [[lymph nodes]] which are abnormal in size, number or consistency. Common causes of lymphadenopathy are [[infection]], [[autoimmune]] disease, or [[malignancy]].  Lymphadenopathy may be classified according to distribution into 2 groups: generalized lymphadenopathy and localized lymphadenopathy. The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of [[lymphocytes]] into the node from the blood, exceeding the rate of outflow from the node. Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and [[B cells]] (clonal expansion). Lymphadenopathy is very common,  the estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%. Patients of all age groups may develop lymphadenopathy. Lymphadenopathy is more commonly observed among children. Common complications of lymphadenopathy, may include: [[Abscess|abscess formation]], [[superior vena cava syndrome]], and [[intestinal obstruction]].  Diagnostic criteria for [[malignant]] lymphadenopathy, may include: node > 2 cm, node that is draining, hard, or fixed to underlying tissue, atypical location (e.g. [[supraclavicular]] node), associated risk factors (e.g. [[HIV AIDS|HIV]] or [[Tuberculosis|TB]]), fever and/or weight loss, and [[splenomegaly]]. On the other hand, diagnostic criteria for [[benign]] lymphadenopathy, may include: node < 1 cm, node that is mobile, soft-or tender, and is not fixed to underlying tissue, typical location (e.g. supraclavicular node), no associated risk factors, and palpable and painful enlargement. Laboratory findings consistent with the diagnosis of lymphadenopathy may include elevated lactate dehydrogenase (LDH), mild neutropenia, and [[leukocytosis]]. There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.
'''Lymphadenopathy''' (also known as "enlarged lymph nodes") refers to [[lymph nodes]] which are abnormal in size, number or consistency. Common causes of lymphadenopathy are [[infection]], [[autoimmune]] disease, or [[malignancy]].  Lymphadenopathy may be classified according to distribution into 2 groups: generalized lymphadenopathy and localized lymphadenopathy. The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of [[lymphocytes]] into the node from the blood, exceeding the rate of outflow from the node. Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and [[B cells]] (clonal expansion). Lymphadenopathy is very common,  the estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%. Patients of all age groups may develop lymphadenopathy. Lymphadenopathy is more commonly observed among children. Common complications of lymphadenopathy, may include: [[Abscess|abscess formation]], [[superior vena cava syndrome]], and [[intestinal obstruction]].  Diagnostic criteria for [[malignant]] lymphadenopathy, may include: node > 2 cm, node that is draining, hard, or fixed to underlying tissue, atypical location (e.g. [[supraclavicular]] node), associated risk factors (e.g. [[HIV AIDS|HIV]] or [[Tuberculosis|TB]]), fever and/or weight loss, and [[splenomegaly]]. On the other hand, diagnostic criteria for [[benign]] lymphadenopathy, may include: node < 1 cm, node that is mobile, soft-or tender, and is not fixed to underlying tissue, typical location (e.g. supraclavicular node), no associated risk factors, and palpable and painful enlargement. Laboratory findings consistent with the diagnosis of lymphadenopathy may include elevated lactate dehydrogenase (LDH), mild neutropenia, and [[leukocytosis]]. There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.
==Diagnosis==
===Other Imaging Findings===
[[Positron emission tomography]] ([[PET]]) is used to evaluate clinically diagnosed [[lymphadenopathy]].
===Primary Prevention===
Good general health and hygiene are helpful in the prevention of any infection.
==Historical Perspective==
==Classification==
Lymphadenopathy may be classified according to distribution into 2 groups localized lymphadenopathy and generalized lymphadenopathy.


==Pathophysiology==
==Pathophysiology==
Line 38: Line 52:
:*[[Necrosis]]
:*[[Necrosis]]
:*No PMNs
:*No PMNs
==Epidemiology and Demographics==
The estimated incidence of [[lymphadenopathy]] in children in the United States ranges from 35%- 45%. It is more common in the pediatric population. Race and gender have no predilection in lymphadenopathy incidence.
==Diagnosis==
===Other Imaging Findings===
[[Positron emission tomography]] ([[PET]]) is used to evaluate clinically diagnosed [[lymphadenopathy]].
==Treatment==
===Surgery===
Surgical care involves open [[biopsy]] or aspiration of the lymph node and its removal.
===Primary Prevention===
Good general health and hygiene are helpful in the prevention of any infection.
==Historical Perspective==
==Classification==
Lymphadenopathy may be classified according to distribution into 2 groups localized lymphadenopathy and generalized lymphadenopathy.
==Pathophysiology==
==Causes==
==Causes==


Line 64: Line 58:


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The estimated incidence of [[lymphadenopathy]] in children in the United States ranges from 35%- 45%. It is more common in the pediatric population. Race and gender have no predilection in lymphadenopathy incidence.


==Risk Factors==
==Risk Factors==
Line 111: Line 106:
==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
 
The medical therapy depends upon the underlying cause. Appropriate antibiotics are given for infective causes. [[Glucocorticoids]] for autoimmune conditions like [[sarcoidosis]], and chemotherapy and radiation for malignant causes.
=== Interventions ===
 
===Surgery===
===Surgery===
 
Surgery is not the first-line treatment option for patients with lymphadenopathy. Surgery is usually reserved for patients with either malignancy and an indication of biopsy. It involves removal or aspiration of lymph nodes. They are dissected when the cancer is in an advanced stage.
===Primary Prevention===
===Primary Prevention===



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Lymphadenopathy (also known as "enlarged lymph nodes") refers to lymph nodes which are abnormal in size, number or consistency. Common causes of lymphadenopathy are infection, autoimmune disease, or malignancy. Lymphadenopathy may be classified according to distribution into 2 groups: generalized lymphadenopathy and localized lymphadenopathy. The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of lymphocytes into the node from the blood, exceeding the rate of outflow from the node. Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion). Lymphadenopathy is very common, the estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%. Patients of all age groups may develop lymphadenopathy. Lymphadenopathy is more commonly observed among children. Common complications of lymphadenopathy, may include: abscess formation, superior vena cava syndrome, and intestinal obstruction. Diagnostic criteria for malignant lymphadenopathy, may include: node > 2 cm, node that is draining, hard, or fixed to underlying tissue, atypical location (e.g. supraclavicular node), associated risk factors (e.g. HIV or TB), fever and/or weight loss, and splenomegaly. On the other hand, diagnostic criteria for benign lymphadenopathy, may include: node < 1 cm, node that is mobile, soft-or tender, and is not fixed to underlying tissue, typical location (e.g. supraclavicular node), no associated risk factors, and palpable and painful enlargement. Laboratory findings consistent with the diagnosis of lymphadenopathy may include elevated lactate dehydrogenase (LDH), mild neutropenia, and leukocytosis. There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.


Diagnosis

Other Imaging Findings

Positron emission tomography (PET) is used to evaluate clinically diagnosed lymphadenopathy.

Primary Prevention

Good general health and hygiene are helpful in the prevention of any infection.


Historical Perspective

Classification

Lymphadenopathy may be classified according to distribution into 2 groups localized lymphadenopathy and generalized lymphadenopathy.

Pathophysiology

Lymph nodes are part of the immune system. As such, they are most readily palpable when fighting infections. Infections can either originate from the organs that they drain or primarily within the lymph node itself, referred to as lymphadenitis.*The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of lymphocytes into the node from the blood, exceeding the rate of outflow from the node.[1]

  • The inmune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the lymph nodes.
  • Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).
  • On gross pathology, characteristic findings of lymphadenopathy, include:
  • Enlarged lymph node
  • Soft greasy yellow areas within capsule
  • On microscopic histopathological analysis, characteristic findings of lymphadenopathy will depend on the aetiology.
  • Common findings, include:[1][2]

Non-specific reactive follicular hyperplasia (NSRFH)

  • Large spaced cortical follicles
  • Tingible body macrophages, normal dark/light GC pattern

Lymph node metastasis

  • Foreign cell population (usually in subcapsular sinuses)
  • +/-nuclear atypia
  • +/-malignant architecture

Toxoplasmosis

  • Large follicles
  • Epithelioid cells perifollicular & intrafollicular
  • Reactive GCs
  • Monocytoid cell clusters

Cat-scratch disease

  • PMNs in necrotic area
  • "Stellate" (or serpentine) shaped micro-abscesses
  • Presence of granulomas

Dermatopathic lymphadenopathy

  • Melanin-laden histiocytes
  • Histiocytosis

Systemic lupus erythematosus lymphadenopathy

  • Blue hematoxylin bodies
  • Necrosis
  • No PMNs

Causes

Differentiating Xyz from Other Diseases

Epidemiology and Demographics

The estimated incidence of lymphadenopathy in children in the United States ranges from 35%- 45%. It is more common in the pediatric population. Race and gender have no predilection in lymphadenopathy incidence.

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

Malignant Lymphadenopathy

Benign Lymphadenopathy

  • Node < 1 cm
  • Node that is mobile, soft-or tender, and is not fixed to underlying tissue
  • Common location (e.g. supraclavicular node)
  • No associated risk factors
  • Palpable and painful enlargement

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

The medical therapy depends upon the underlying cause. Appropriate antibiotics are given for infective causes. Glucocorticoids for autoimmune conditions like sarcoidosis, and chemotherapy and radiation for malignant causes.

Surgery

Surgery is not the first-line treatment option for patients with lymphadenopathy. Surgery is usually reserved for patients with either malignancy and an indication of biopsy. It involves removal or aspiration of lymph nodes. They are dissected when the cancer is in an advanced stage.

Primary Prevention

Secondary Prevention

References

  1. 1.0 1.1 Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  2. Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016
  3. Deschenes J, Seamone CD, Baines MG (1992). "Acquired ocular syphilis: diagnosis and treatment". Ann Ophthalmol. 24 (4): 134–8. PMID 1590633.

References

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